Cardiovascular & Lymphatic Systems Assessment

Focus The cardiovascular system plays an essential role in the delivery of oxygenated blood to the
tissues and removal of wastes. An effective cardiovascular assessment, identifies present or potential
health issues and informs appropriate health promotional practices including an exercise program.
Techniques used in cardiovascular assessment include health history interview, inspection, palpation,
percussion and auscultation. The lymphatic system is an extensive network which like the circulatory
system serves all cells in the body. It consists of lymph vessels and nodes which help to protect and
maintain the internal fluid environment of the whole body by producing, filtering and conveying lymph
and producing certain blood cells. Assessment determines its functioning and response to
microorganisms

Learning Objectives
By the end of todays lab the student will be able to:
1. conduct a subjective and objective assessment of the central and peripheral vascular systems.
2. correctly locate anatomic landmarks on the chest wall
3. demonstrate correct technique for inspection and palpation of the neck vessels
4. demonstrate correct techniques for inspection, palpation, and auscultation of the
precordium
5. demonstrate palpation of central and peripheral arterial pulses (carotid, radial, ulnar,
brachial, popliteal, posterior tibial, dorsalis pedis) & describe apical and femoral palpation
techniques.
6. demonstrate palpation of lymph nodes in the head and neck, and identify expected normal
findings
7. accurately document findings of assessment of the central and peripheral vascular and
lymphatic systems

Rationale Physical Assessment of the cardioand peripheral-vascular and lymphatic systems

requires knowledge and application of theory to ensure competent technique. Vital signs are
used to support the objective and subjective findings. Detecting changes in these systems at an
early stage can assist in timely interventions of health promotion and illness prevention
Preparation - PRIOR TO ATTENDING THE LAB: Students will have first view 2 relevant videos
from the Health Assessment DVD series: o cardiovascular system: heart and neck vessels o
cardiovascular system: peripheral vascular system and lymphatics

Learning activity 1: (Work in pairs or small groups of 2-3)

Skills that require development include: S1 & S2 heart sounds and auscultating the apical pulse;
inspecting neck vessels and considering Jugular venous pressure (JVP); auscultating for vascular
bruits.
Central Venous System
1. Position patient in the supine or semi-Fowlers position. Consider comfort & privacy - ensure
draping to avoid unnecessary exposure.

Inspect the sterno-clavicular, aortic, pulmonic, right ventricular, apical & epigastric area
for pulsations, heaves, thrills.
Identify the internal and external jugular veins. Observe the pulsations.
Observe in the suprasternal region for carotid pulsations
Elevate the bed to 45 degree. Consider jugular vein distension
2. The following percussion technique requires consent & may not be achievable on a female
patient:

Percuss the left cardiac border toward the midline in 3rd, 4th, & 5th Intercostal spaces
(ICS).
Measure from the point of left cardiac border dullness to the midsternal line.

The Heart and Pulses

1. Palpate the peripheral pulses: brachial, radial, ulnar, popliteal, dorsalis pedis &
posterior tibial.
2. Auscultate heart sounds in supine, left lateral & forward leaning positions.
3. With the consent of your practice partner, auscultate heart sounds in each of the
4 valve areas using the diaphragm & bell.
4. Identify S1 by listening at the apex and palpating the carotid pulse in unison.
5. Listen for the short pause between S1 and S2 and the longer pause between S2
and S1. What is the clients heart rate?
6. Listen to the S1 / S2 separately, and record intensity and presence of splitting. If this is not
audible for the client, use available interactive resources
7. Document these findings.

The Lymphatic System

Palpate the epitrochlear node in the antecubital fossa
Palpate other palpable head and neck lymph nodes
Identify the names of all head & neck nodes.
A model and poster of the great vessels will be available in the lab to reinforce anatomical
structures and
landmarks. Use double-headed stethoscopes to compare results with your practice partner.

SDL
Questions to prompt study for OSCA and end of semester exam (these are not to be completed
in class rather in your own time or in a study group with your peers)
Heart & Neck Vessels
1. define the apical impulse & describe its normal location, size & duration. Which normal
variations may affect the location of the apical impulse?
2. explain the mechanism producing normal 1st & 2nd heart sounds
3. describe the effect of respiration on the heart sounds
4. describe the characteristics of the first heart sound (S1) & its intensity at the apex of the
heart and at the base
5. explain the physiologic reason for normal splitting of S2 in the pulmonic valve area
6. explain the position of the valves during each phase of the cardiac cycle
7. define venous pressure and jugular venous pulse
8. differentiate between the carotid artery pulsation & jugular venous pulsation
9. list the areas of questioning to address during the health history for cardiovascular
system assessment
10. define bruit & discuss what it indicates
11. discuss 4 guidelines to distinguish S1 from S2
12. define pulse deficit and discuss what it indicates
Peripheral Vascular System & Lymphatic System
1. describe the structure & function of arteries & veins
2. list the pulse sites accessible to examination
3. describe 3 mechanisms that help return venous blood to the heart
4. define the term capacitance vessels & explain its significance
5. list the risk factors for venous stasis
6. describe the function of the lymphatic system
7. describe the function of the lymph nodes
8. name the related organs in the lymphatic system
9. identify the grading system for assessing the force of an arterial pulse
10. fill in the description of the grading scale for pitting oedema: